The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons

Objective:To assess the impact of the 80-hour resident workweek restrictions on surgical residents and attending surgeons. Summary Background Data:The ACGME mandated resident duty hour restrictions have required a major workforce restructuring. The impact of these changes needs to be critically evaluated for both the resident and attending surgeons, specifically with regards to the impact on motivation, job satisfaction, the quality of surgeon training, the quality of the surgeon's life, and the quality of patient care. Methods:Four prospective studies were performed at a single academic surgical program with data collected both before the necessary workforce restructuring and 1 year after, including: 1) time cards to assess changes in components of daily activity; 2) Web-based surveys using validated instruments to assess burnout and motivation to work; 3) structured, taped, one-on-one interviews with an external PhD investigator; and 4) statistical analyses of objective, quantitative data. Results:After the work-hour changes, surgical residents have decreased “burnout” scores, with significantly less “emotional exhaustion” (Maslach Burnout Inventory: 29.1 “high” vs. 23.1 “medium,” P = 0.02). Residents have better quality of life both in and out of the hospital. They felt they got more sleep, have a lighter workload, and have increased motivation to work (Herzberg Motivation Dimensions). We found no measurable, statistically significant difference in the quality of patient care (NSQIP data). Resident training and education objectively were not statistically diminished (ACGME case logs, ABSITE scores). Attending surgeons perceived that their quality of their life inside and outside of the hospital was “somewhat worse” because of the work-hour changes, as they had anticipated. Many concerns were identified with regards to the professional development of future surgeons, including a change toward a shift-worker mentality that is not patient-focused, less continuity of care with a loss of critical information with each handoff, and a decrease in the patient/doctor relationship. Conclusion:Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.

[1]  H. Sanfey,et al.  Effect of the 80-Hour Work Week on Cases Performed by General Surgery Residents , 2005, The American surgeon.

[2]  Katherine C. Kellogg,et al.  Effect of work-hour reforms on operative case volume of surgical residents. , 2005, Current surgery.

[3]  Michelle C Specht,et al.  Effects of limited work hours on surgical training. , 2002, Journal of the American College of Surgeons.

[4]  S. Wilson,et al.  Effect of the 80-hour workweek on resident burnout. , 2004, Archives of surgery.

[5]  Julian M Goldman,et al.  Introducing new technology into the operating room: measuring the impact on job performance and satisfaction. , 2005, Surgery.

[6]  A. Warshaw,et al.  The now and future world of restricted work hours for surgeons. , 2003, Surgery.

[7]  R. McLeod,et al.  The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. , 1995, Journal of the American College of Surgeons.

[8]  P. Termuhlen,et al.  Before and after resident work hour limitations: an objective assessment of the well-being of surgical residents. , 2005, Current surgery.

[9]  W. Schaufeli,et al.  Job burnout. , 2001, Annual review of psychology.

[10]  S. Ashley,et al.  Implementing resident work hour limitations: lessons from the New York State experience. , 2003, Annals of surgery.

[11]  W. Henderson,et al.  The National Surgical Quality Improvement Program in Non-Veterans Administration Hospitals: Initial Demonstration of Feasibility , 2002, Annals of surgery.

[12]  M. Kluger,et al.  Job satisfaction, stress and burnout in Australian specialist anaesthetists , 2003, Anaesthesia.

[13]  L. McMahon,et al.  Effects of work hour reduction on residents' lives: a systematic review. , 2005, JAMA.

[14]  J. Fischer Continuity of Care: A Casualty of the 80-Hour Work Week , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[15]  S. Ashley,et al.  Work hours reform: perceptions and desires of contemporary surgical residents. , 2003, Journal of the American College of Surgeons.

[16]  C. Pellegrini,et al.  Professionalism and the shift mentality: how to reconcile patient ownership with limited work hours. , 2005, Archives of surgery.

[17]  L. Greenfield,et al.  Burnout among American surgeons. , 2001, Surgery.

[18]  A. Meyer,et al.  Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study. , 2005, Surgery.

[19]  F. Grover,et al.  Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1997, Journal of the American College of Surgeons.

[20]  S. Ashley,et al.  Surgical residents' perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. , 2005, Surgery.

[21]  L. Britt,et al.  Resident operative experience during the transition to work-hour reform. , 2005, Archives of surgery.

[22]  J. Drazen,et al.  Rethinking medical training--the critical work ahead. , 2002, The New England journal of medicine.

[23]  K. Itani,et al.  Does resident hours reduction have an impact on surgical outcomes? , 2005, The Journal of surgical research.

[24]  F. Grover,et al.  The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. , 1998, Annals of surgery.

[25]  I. McManus,et al.  The causal links between stress and burnout in a longitudinal study of UK doctors , 2002, The Lancet.